Carrying multiples: What to expect

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Posted on: 18 January 2015

Carrying multiples: What to expect

More women these days can expect to have twins than in the past. Over the last twenty years, multiple births have risen sharply, probably due to the rise in use of fertility treatments the fact that many women are choosing to start families later in life.

As women get older, their ovaries are likely to release more than one egg each month. In 2005, the Twin and Multiple Birth Association (TAMBA) say women in the UK gave birth to 10,533 sets of twins.

Dionne Pemberton, 36, describes the moment she found out she was having twins. "When I found out, I burst out laughing and crying at the same time,” says Dionne. “I had so much emotion I couldn’t control it. I thought the chances of having twins was about one in a million - how could it have happened to me?” In reality, according to Twins UK, the probability of conceiving twins for the average British woman is about 1.5 in 100, or 1.5 per cent.

For many parents, finding out that they are soon to be parents to two babies at the same time is a shock. Although undoubtedly exciting news, it can also be extremely daunting to contemplate a 2.4 family situation arriving in less than nine months time.

A Twin Pregnancy

Even if this pregnancy is not your first, being pregnant with two babies is a completely different experience to your previous singleton pregnancy.Aside from all the usual symptoms that occur with a pregnancy, there are definitely extra demands made on your body when you are carrying twins.

Dionne says: "Because the bump arrives so early with twins, it’s like being pregnant for a really long time."

For this reason, it may be hard to keep your pregnancy a secret during the first trimester, as you could start showing as early as eight weeks. Tellingly, your baby bulge may also appear prominent at the sides as well as the front of your body, unlike the early days of a singleton pregnancy.

So, unless you suddenly develop a penchant for floaty layered clothing, you might have to resign yourself to the inevitable questions and curiosity that will come your way. Console yourself with the knowledge that full-term for twins is considered to be 37 weeks rather than 40, so although you might be showing your pregnancy early on, you will probably be free of your bump a little sooner than your average carrier of one.

Women who are carrying twins can expect to gain as much as 25kg (four stone) during the course of their pregnancy, but the weight gain may be lower for you, depending on your height, weight and health. Your midwife will be able to advise you on what is appropriate for your body.

Other problems may arise due to your size. Dionne suffered with a skin condition known as PUPPS, which can occur when your skin stretches very quickly. “I was itchy on and off all the time,” she says. It often occurs in the third trimester and causes red and itchy bumps to spread across the stomach, thighs, buttocks and sometimes even the breasts and arms. Try using a natural soothing lotion such as calamine if you suspect you have this, and seek medical advice.

Mentally prepare yourself for plenty of rest during this pregnancy. Your blood volume with twins is nearly double your pre-pregnant level, which means your heart is going to be working much harder than normal and you may suffer with fatigue.

You may be more at risk from anaemia, as your need for iron to make enough red blood cells increases at this time, and undoubtedly you will find yourself quite tired as your body fights to work under pressure. Don’t make too many demands of yourself.

If you are feeling under the weather in any way with your pregnancy, try to negotiate later mornings or a portion of work from home with your employers. Try to create time that you can rest and do activities and exercise that help you to relax such as pregnancy yoga or swimming.

Twin pregnancy care

It is likely that your doctors and midwives will want to monitor your progress very attentively due to the increased risk of medical complications, such as pre-eclampsia, that have the potential to accompany multiple pregnancies. If you already have any existing health problems, like diabetes, your progress will definitely be monitored very closely.

As a carrier of twin babies, you are generally considered to be at higher risk from medical complications, but this is not to say that you will have any problems at all and certain problems depend on the type of twins you are carrying.

Identical and non-identical twins

If your twins are identical, or so-called ‘monozygotic’, this means that your fertilised egg divided in half, forming two separate babies. Sometimes identical twins share only one amniotic sac (monoamniotic) and outer membrane (monochorionic), which can lead to something known as TTTS (twin to twin transfusion syndrome) and means that one twin doesn’t thrive as well as the other.

However, this is not the case for all monozygotic twins and identical babies may share a membrane but have separate amniotic sacs. Even more commonly, women carry fraternal (non-identical) or ‘dizygotic’ twins, which means that two separate eggs were fertilised by two separate sperm and therefore have their own membrane and amniotic sac. These types of pregnancies will be considered lower risk.

It is likely you will visit a midwife and a consultant at separate times on a monthly basis for close monitoring of your pregnancy and you should expect an increase in ultrasound scans and clinic apointments, especially during the later stages.

Emotional implications

As well as dealing with the physical demands of carrying two babies, you also need to factor in the emotional implications. Discovering you are pregnant with twins can be a huge shock for yourself and your partner and you shouldn’t underestimate the range of feelings that you may be working through.

Try to make time as a couple to explore your feelings on this subject and keep the communication lines open. Remember that your partner may be experiencing the same amount of anxiety as you and try to include him in the pregnancy process as much as possible to help allay his, as well as your own, fears.

“My partner found it a big comfort to read lots of books about twins during our pregnancy,” says Dionne.

Antenatal classes are an excellent way for you both to learn more about pregnancy and labour and preparing you for the huge changes to come. They also provide a safe place to ask questions and meet other expectant couples.

It can be really useful to meet other parents of twins before yours arrive, so use gurgle to put yourself in touch with our groups area to meet other members who have experienced twin pregnancies too.

Your twin birth

Be aware that the birth you want may not be possible on the day and try not to make yourself feel guilty about this. Having determined expectations are admirable, but labour is a unique experience and the likelihood of complications occurring with twins is naturally going to be higher than with just one baby.

It is important to prepare yourself that things may not go quite according to plan and not worry. For example, you will probably not be able to have a home birth; or you may feel very strongly about having a vaginal birth but end up having a Caesarean, but these factors don’t mean that you have to lose control over the experience. Make a birth plan, but expect to be flexible. Dionne Pemberton’s babies were both breech, which meant she had to have a Caesarean section. “I felt nervous as I had never had surgery or been hospitalised before and the experience was more intense than I expected," she says.

"There were lots of people in the room and I was given drugs which made me feel a little disconnected.”

The important thing to remember if you do need to have a Caesarean section is that you are going to need extra support on a physical level afterwards as it will take longer to recover from surgery.

Try not to feel disappointed, if you were set on having a vaginal delivery, such decisions about delivery methods are taken to ensure the safety of your babies.

One of the biggest risks with multiple pregnancies is that you will go into labour prematurely. Although 37 weeks is full-term for a twin pregnancy, it is likely that your babies may decide to make an appearance sooner. Half of all twins are born at 36 weeks, but thanks to huge advances in medical technology, babies born prematurely have excellent survival rates.

Try not to waste energy now, worrying about the labour, but make sure you are prepared to go into hospital. Packing your bags early is a good idea.

The first six months

You may be wondering how on earth you are going to cope with two newborns, but the answer is, you will! Thousands of people do it every year and you will too. Of course it will be challenging at times, but doubly rewarding too. Being parent to twins is a different experience completely to parenting a singleton, and you will soon learn the ropes.

Dionne says her husband had more chance to get hands on with their twins. “If a woman has one baby, the man often tends not to get a look in, but with two babies, it is almost like being two single parents in the beginning because so much needs to be done.”

Obviously, you are going to need as much support as you can get. If you haven’t done so already, discuss with your partner how you are going to be able to help each other when your babies are born.

Some experts are adamant that you need to get your babies into a strict feeding and sleeping schedule, but you will have to decide what works best for your family. Dionne says her best advice is that you should enjoy your twins and not get too hung-up about making life manageable.

“The first 12 weeks can be overwhelming, but go with the flow and keep calm. You can’t control anything.” She also says that she likes being able to spend individual time with one twin when the other is asleep. This bonding time wouldn’t be possible, she explains, if the babies were on a synchronised schedule.

People often wonder how parents cope with two babies crying in unison, but Dionne says it is inevitable that one baby is left crying sometimes. She feels her babies have become more independent and manageable more quickly, as they know they have to share her time and, accordingly, they rarely cry at the same time.

Domestic chores sometimes have to wait when you have twin babies, but often distractions come in the form of other people. As a parent of twins, Dionne finds that she and her babies are the object of fascination to passersby, which can sometimes slow up her passage from A to B. If in a hurry when out walking around, she has a top tip for mums. “Put a sarong over your pushchair, so that people can’t see what is inside and stop you constantly to chat.

It is a costly business being a parent to twins and unfortunately the government does not provide any extra financial help for two babies. Make sure you are receiving tax credits if you are entitled to them and investigate the situation regarding your paternity and maternity leave.

If you are both going to be returning to work, then you will also need to factor-in child care cost, which can be very high with two children. An au-pair or nanny might be a better alternative to a nursery and a touch cheaper than paying nursery fees for two.

Finally, Dionne advises parents to make sure they enjoy their twins. "Don’t put too much pressure on yourself and you’ll survive the early days."

The information in this feature is intended for educational purposes only. If you have any concerns about your health, the health of your child or the health of someone you know, please consult with a doctor or other healthcare professional.